2型糖尿病合并肥胖患者的甲状腺轴微紊乱及其对胰岛素抵抗的影响

摘要

目的：观察2型糖尿病(type 2 diabetes mellitus,T2DM)合并肥胖患者的甲状腺轴微紊乱及其对胰岛素抵抗的影响。方法选择初发肥胖T2DM患者200例为T2DM组和符合肥胖者的健康体检者100例为糖耐量正常(normal glucose tolerance,NGT )组。比较 T2DM 组和 NGT 组血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺素(thyroid stimulating hormone,TSH)、稳态胰岛素评价指数(homeostasis model of assessment for insulin resistance,HOMA-IR)及糖化血红蛋白(hemoglobin A1 c,HbA1 c)水平,比较不同 HbA1 c 水平 T2DM患者血清 FT3、FT4、TSH、HOMA-IR 水平,观察甲状腺激素与HOMA-IR的相关性。结果 T2DM组FT3和FT4水平明显低于NGT组,TSH、HOMA-IR和HbA1 c水平明显高于NGT组(P<0.05)。T2DM患者 FT3和 FT4水平随着 HbA1 c 水平增高而降低,TSH、HOMA-IR随着 HbA1 c水平增高而增高(P<0.05)。治疗后T2DM患者FT3、FT4水平明显高于治疗前,TSH、HOMA-IR和 HbA1 c水平明显低于治疗前(P<0.05)。T2DM 患者 FT3和 FT4水平与 HOMA-IR 呈负相关(r=-0.781、-0.564,P<0.05),TSH 水平与 HOMA-IR呈正相关(r=0.648,P<0.05)。结论 T2DM合并肥胖患者存在甲状腺轴微紊乱和胰岛素抵抗,甲状腺轴微紊乱与胰岛素抵抗具有明显相关性,治疗 T2DM有助于缓解甲状腺轴微紊乱和胰岛素抵抗。%Objective To observe the micro-disorders of thyroid axis in patients with type 2 diabetes mellitus (T2DM)and obesity,and their impact on insulin resistance.Methods Two hundred patients with T2DM and first discovery of obesity were selected as T2DM group.One hundred obesity persons were selected as normal glucose tolerance (NGT)group at the same period.The levels of free triiodothyronine (FT3 ),free thyroxine (FT4 ),thyroid stimulating hormone(TSH),homeostasis model of assessment for insulin resistance (HOMA-IR)and hemoglobin A1 c(HbA1 c)were observed in T2DM and NGT group before and after treatment. The levels of FT3 ,FT4 ,TSH,HOMA-IR and HbA1 c were observed in T2DM group with different HbA1 c levels,and the correlation between thyroid hormone and HOMA-IR were also observed.Results The levels of FT3 and FT4 in T2DM group were significantly lower than those in NGT group,and the levels of TSH,HOMA-IR and HbA1 c were significantly higher than those in NGT group(P<0.05).The FT3 and FT4 levels decreased with the increase of HbA1 c level.And the levels of TSH,HOMA-IR in T2DM group increased with the increase of HbA1 c level (P< 0.05 ).After treatment, the levels of FT3 and FT4 were significantly increased compared with before treatment, while, the levels of TSH, HOMA-IR and HbA1 c were significantly lower compared with those before treatment(P<0.05).The levels of FT3 and FT4 were negatively correlated to the levels of HOMA-IR(r=-0.781,-0.564,P<0.05),and there were positively correlated between TSH and HOMA-IR levels(r=0.648,P<0.05).Conclusion There are thyroid axis micro disorder and insulin resistance in patients with T2DM and obesity, and thyroid axis micro disorder is correlated significantly to insulin resistance.Treatment of T2DM is helpful in alleviating the thyroid dysfunction and insulin resistance.